General aspects about how to start with MISS

• You need good surgical skills and surgico-anatomical knowledge before starting with MISS.
• Therefore, you should be skilled in open surgery before switching to MISS.
• Although you can perform MISS with magnifying glasses the use of a microscope is advocated.
• If you switch to a microscope first perform several procedures with your own technique before starting with MISS.

Your first patients

• Should be between 14 and 40 years in order to avoid abundant Tenon’s tissue or conjunctival tearing
• Start with primary horizontal rectus muscle displacements of 4 mm or less
• Perform rectus muscle marginal dissection (MADI) tucks instead of recessions to avoid unnecessary bleeding
• Use a corneolimbal traction suture for optimal visualization to avoid rubbing on the cornea
• Use small instuments to operate through MISS openings
• Large instruments reduce the visibility of the operating site and may tear the conjunctiva
• Don’t perform MISS transconjunctival suturing (TRASU) techniques, MISS reoperations, MISS in strongly restricted strabismus, MISS faden before being well accustomed with basic MISS techniques

Changes of dose-response relationships

• If MISS displacements are performed in the same way as before with open surgery, dose-response relationships will not change markedly
• Usually, tucks (plications), MADI tucks, and resections yield the same dose-response relationship
• Despite that, it is advisable to look for changes after switching to MISS

Read about MISS and visit a MISS surgeon

• Read about MISS publications, planned MISS talks, MISS courses and MISS wetlabs on the publication website
• Eye surgeons can contact us to visit a skilled MISS surgeon in his operating theater